Introduction: We aimed to perform a multi-institutional study using a national database led by the Japanese Society of Endourology to investigate the effect of surgeon or hospital volume on the safety of robot-assisted radical prostatectomy (RARP). Materials and Methods: Clinical data of 3,214 patients who underwent RARP for the treatment of clinically localized prostate cancer between April 2012 and March 2013 in Japan were evaluated. Surgical outcomes and all intra- and perioperative complications were collected. Results: The intraoperative complication rate was 0.56%. In a total number of 241 patients, 261 perioperative complications were observed. The following percentages of patients presented the Clavien-graded complications: 7.2%, grades 1-2; 0.84%, grade 3; and 0.093%, grade 4a. No cases of multiple organ dysfunction or death (grades 4b and 5) were found. Multivariable logistic regression analysis showed that the hospital volume (OR 3.6; p = 0.010) for intraoperative complications and surgeon volume (OR 0.19; p < 0.0001) and extended lymph node discectomy (OR 3.9; p < 0.0001) for perioperative complications were significant independent risk factors. Conclusions: Hospital volume for intraoperative complications and surgeon volume and extended lymph node dissection for perioperative complications were significantly associated with increased risk of each complication in RARP.

Keywords:
Robot-assisted radical prostatectomy, Safety, Multi-institutional study, Learning curve
1.
Hirasawa Y, Ohno Y, Nakashima J, et al: Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon's experience with robot-assisted radical prostatectomy. Surg Endosc 2016;30:3702-3708.
2.
Schiffmann J, Haese A, Lenz J, et al: Differences in patient characteristics among men choosing open or robot-assisted radical prostatectomy in contemporary practice at a European high-volume center. Urol Int 2016;97:8-15.
3.
Schiffmann J, Larcher A, Sun M, et al: Differences in patient characteristics among men choosing open or robot-assisted radical prostatectomy in contemporary practice - analysis of surveillance, epidemiology, and end results database. Urol Int 2017;98:40-48.
4.
Sugihara T, Yasunaga H, Horiguchi H, et al: Robot-assisted versus other types of radical prostatectomy: population-based safety and cost comparison in Japan, 2012-2013. Cancer Sci 2014;105:1421-1426.
5.
Patel VR, Palmer KJ, Coughlin G, et al: Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases. J Endourol 2008;22:2299-2305.
6.
Coelho RF, Palmer KJ, Rocco B, et al: Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system. Eur Urol 2010;57:945-952.
7.
Trinh QD, Sammon J, Sun M, et al: Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 2012;61:679-685.
8.
Budaus L, Sun M, Abdollah F, et al: Impact of surgical experience on in-hospital complication rates in patients undergoing minimally invasive prostatectomy: a population-based study. Ann Surg Oncol 2011;18:839-847.
9.
Choi WW, Gu X, Lipsitz SR, et al: The effect of minimally invasive and open radical prostatectomy surgeon volume. Urol Oncol 2012;30:569-576.
10.
Clavien PA, Sanabria JR, Strasberg SM: Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111:518-526.
11.
Lowrance WT, Elkin EB, Jacks LM, et al: Comparative effectiveness of prostate cancer surgical treatments: a population based analysis of postoperative outcomes. J Urol 2010;183:1366-1372.
12.
Hu JC, Wang Q, Pashos CL, et al: Utilization and outcomes of minimally invasive radical prostatectomy. J Clin Oncol 2008;26:2278-2284.
13.
Bianco FJ Jr, Riedel ER, Begg CB, et al: Variations among high volume surgeons in the rate of complications after radical prostatectomy: further evidence that technique matters. J Urol 2005;173:2099-2103.
14.
Judge A, Evans S, Gunnell DJ, et al: Patient outcomes and length of hospital stay after radical prostatectomy for prostate cancer: analysis of hospital episodes statistics for England. BJU Int 2007;100:1040-1049.
15.
Yao SL, Lu-Yao G: Population-based study of relationships between hospital volume of prostatectomies, patient outcomes, and length of hospital stay. J Natl Cancer Inst 1999;91:1950-1956.
16.
Hu JC, Gold KF, Pashos CL, et al: Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol 2003;21:401-405.
17.
Sammon JD, Karakiewicz PI, Sun M, et al: Robot-assisted versus open radical prostatectomy: the differential effect of regionalization, procedure volume and operative approach. J Urol 2013;189:1289-1294.
18.
Ploussard G, Briganti A, de la Taille A, et al: Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications - a systematic review of the literature. Eur Urol 2014;65:7-16.
19.
Vittimberga FJ Jr, Foley DP, Meyers WC, et al: Laparoscopic surgery and the systemic immune response. Ann Surg 1998;227:326-334.
20.
Novara G, Ficarra V, Rosen RC, et al: Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 2012;62:431-452.
21.
Agarwal PK, Sammon J, Bhandari A, et al: Safety profile of robot-assisted radical prostatectomy: a standardized report of complications in 3317 patients. Eur Urol 2011;59:684-698.
22.
Badani KK, Kaul S, Menon M: Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 2007;110:1951-1958.
23.
Menon M, Shrivastava A, Kaul S, et al: Vattikuti institute prostatectomy: contemporary technique and analysis of results. Eur Urol 2007;51:648-657; discussion 657-658.
24.
Pilecki MA, McGuire BB, Jain U, et al: National multi-institutional comparison of 30-day postoperative complication and readmission rates between open retropubic radical prostatectomy and robot-assisted laparoscopic prostatectomy using NSQIP. J Endourol 2014;28:430-436.
25.
Wedmid A, Mendoza P, Sharma S, et al: Rectal injury during robot-assisted radical prostatectomy: incidence and management. J Urol 2011;186:1928-1933.
26.
Tasci AI, Tufek I, Gumus E, et al: Oncologic results, functional outcomes, and complication rates of robotic-assisted radical prostatectomy: multicenter experience in Turkey including 1,499 patients. World J Urol 2015;33:1095-1102.
27.
Smith AM, Veenema RJ: Management of rectal injury and rectourethral fistulas following radical retropubic prostatectomy. J Urol 1972;108:778-779.
28.
Catalona WJ, Carvalhal GF, Mager DE, et al: Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 1999;162:433-438.
29.
Borland RN, Walsh PC: The management of rectal injury during radical retropubic prostatectomy. J Urol 1992;147(3 pt 2):905-907.
30.
Lepor H, Nieder AM, Ferrandino MN: Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases. J Urol 2001;166:1729-1733.
31.
Rassweiler J, Seemann O, Schulze M, et al: Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol 2003;169:1689-1693.
32.
Guillonneau B, Gupta R, El Fettouh H, et al: Laparoscopic [correction of laproscopic] management of rectal injury during laparoscopic [correction of laproscopic] radical prostatectomy. J Urol 2003;169:1694-1696.
33.
Katz R, Borkowski T, Hoznek A, et al: Operative management of rectal injuries during laparoscopic radical prostatectomy. Urology 2003;62:310-313.
© 2017 S. Karger AG, Basel
2017
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